|
HC CAPD DAILY TREATMENT
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000101
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$907.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$539.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.93
|
| Rate for Payer: Blue Distinction Transplant |
$638.40
|
| Rate for Payer: Blue Shield of California Commercial |
$784.17
|
| Rate for Payer: Blue Shield of California EPN |
$621.38
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna of CA HMO |
$680.96
|
| Rate for Payer: Cigna of CA PPO |
$787.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$798.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$907.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$896.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$896.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$638.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$638.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.00
|
| Rate for Payer: United Healthcare All Other HMO |
$532.00
|
| Rate for Payer: United Healthcare HMO Rider |
$532.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
902400137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
902400137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.28
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.25
|
| Rate for Payer: Dignity Health Media |
$55.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.25
|
| Rate for Payer: Vantage Medical Group Senior |
$55.25
|
|
|
HC CAPILLARY HA1C
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
902501902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
|
|
HC CAPILLARY HA1C
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
902501902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.57
|
| Rate for Payer: Blue Distinction Transplant |
$181.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.09
|
| Rate for Payer: Blue Shield of California EPN |
$154.62
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO |
$193.28
|
| Rate for Payer: Cigna of CA PPO |
$223.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Media |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$226.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$15.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC CAPTOPRIL RENOGRAM
|
Facility
|
OP
|
$4,154.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
909301431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$3,530.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$769.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,474.95
|
| Rate for Payer: Blue Distinction Transplant |
$2,492.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,455.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,948.23
|
| Rate for Payer: Cash Price |
$1,869.30
|
| Rate for Payer: Cash Price |
$1,869.30
|
| Rate for Payer: Cigna of CA HMO |
$2,658.56
|
| Rate for Payer: Cigna of CA PPO |
$3,073.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$3,530.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,492.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,770.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,323.20
|
| Rate for Payer: Networks By Design Commercial |
$2,700.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,530.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,492.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,492.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC CAPTOPRIL RENOGRAM
|
Facility
|
IP
|
$4,154.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
909301431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$996.96 |
| Max. Negotiated Rate |
$3,530.90 |
| Rate for Payer: Cash Price |
$1,869.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.60
|
| Rate for Payer: Galaxy Health WC |
$3,530.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,492.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,770.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,582.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.96
|
| Rate for Payer: Multiplan Commercial |
$3,323.20
|
| Rate for Payer: Networks By Design Commercial |
$2,700.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,530.90
|
|
|
HC CARBAMATES CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.08
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.72
|
| Rate for Payer: Dignity Health Media |
$9.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.81
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$15.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.95
|
| Rate for Payer: United Healthcare All Other HMO |
$7.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
|
|
HC CARBAMAZEPINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
900910396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$121.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Media |
$14.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
|
|
HC CARCINOEMBRYONIC ANTIGEN (CEA)
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900910865
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$172.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$157.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.79
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.88
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Media |
$18.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.96
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$31.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.35
|
| Rate for Payer: United Healthcare All Other HMO |
$15.35
|
| Rate for Payer: United Healthcare HMO Rider |
$15.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC CARDIAC ANGIO CONG HEART DZ
|
Facility
|
IP
|
$4,812.00
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
909201406
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,154.88 |
| Max. Negotiated Rate |
$4,090.20 |
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.80
|
| Rate for Payer: Galaxy Health WC |
$4,090.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,887.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,209.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,833.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.88
|
| Rate for Payer: Multiplan Commercial |
$3,849.60
|
| Rate for Payer: Networks By Design Commercial |
$3,127.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,090.20
|
|
|
HC CARDIAC ANGIO CONG HEART DZ
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
909201406
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,653.94
|
| Rate for Payer: Blue Distinction Transplant |
$1,665.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,640.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,301.94
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cigna of CA HMO |
$1,776.64
|
| Rate for Payer: Cigna of CA PPO |
$2,054.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,359.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,082.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: Networks By Design Commercial |
$1,804.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,359.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,665.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,665.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CARDIAC ANGIO, STRUCTURE/MORPH
|
Facility
|
IP
|
$3,957.00
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
909201405
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$949.68 |
| Max. Negotiated Rate |
$3,363.45 |
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,582.80
|
| Rate for Payer: Galaxy Health WC |
$3,363.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.68
|
| Rate for Payer: Multiplan Commercial |
$3,165.60
|
| Rate for Payer: Networks By Design Commercial |
$2,572.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,363.45
|
|
|
HC CARDIAC ANGIO, STRUCTURE/MORPH
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
909201405
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,653.94
|
| Rate for Payer: Blue Distinction Transplant |
$1,665.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,640.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,301.94
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cigna of CA HMO |
$1,776.64
|
| Rate for Payer: Cigna of CA PPO |
$2,054.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,359.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,082.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: Networks By Design Commercial |
$1,804.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,359.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,665.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,665.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CARDIAC MRI VELOCITY FLOW MAPPING
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
908875565
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,400.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$906.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$906.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$981.88
|
| Rate for Payer: Blue Distinction Transplant |
$988.80
|
| Rate for Payer: Blue Shield of California Commercial |
$973.97
|
| Rate for Payer: Blue Shield of California EPN |
$772.91
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna of CA HMO |
$1,054.72
|
| Rate for Payer: Cigna of CA PPO |
$1,219.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,400.80
|
| Rate for Payer: Dignity Health Media |
$1,400.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$659.20
|
| Rate for Payer: Galaxy Health WC |
$1,400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$988.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,236.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,400.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$988.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$988.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,400.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,400.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,400.80
|
|
|
HC CARDIAC MRI VELOCITY FLOW MAPPING
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
908875565
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$395.52 |
| Max. Negotiated Rate |
$1,400.80 |
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.20
|
| Rate for Payer: Galaxy Health WC |
$1,400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$988.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,400.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$789.12 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.99
|
| Rate for Payer: Blue Distinction Transplant |
$1,972.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,943.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.07
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO |
$2,104.32
|
| Rate for Payer: Cigna of CA PPO |
$2,433.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,304.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900802004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$789.12 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900800405
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$789.12 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900802004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.99
|
| Rate for Payer: Blue Distinction Transplant |
$1,972.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,943.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.07
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO |
$2,104.32
|
| Rate for Payer: Cigna of CA PPO |
$2,433.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900800405
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.99
|
| Rate for Payer: Blue Distinction Transplant |
$1,972.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,943.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.07
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO |
$2,104.32
|
| Rate for Payer: Cigna of CA PPO |
$2,433.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,304.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOLIPIN AB EAC IG CLASS
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$211.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.75
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: Dignity Health Media |
$25.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$41.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$857.28 |
| Max. Negotiated Rate |
$3,036.20 |
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.80
|
| Rate for Payer: Galaxy Health WC |
$3,036.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,143.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,382.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.28
|
| Rate for Payer: Multiplan Commercial |
$2,857.60
|
| Rate for Payer: Networks By Design Commercial |
$2,321.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,036.20
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$383.67 |
| Max. Negotiated Rate |
$3,036.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,749.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,128.20
|
| Rate for Payer: Blue Distinction Transplant |
$2,143.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,111.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.27
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna of CA HMO |
$2,286.08
|
| Rate for Payer: Cigna of CA PPO |
$2,643.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$3,036.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,143.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,679.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,382.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,857.60
|
| Rate for Payer: Networks By Design Commercial |
$2,321.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,036.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,143.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,143.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
